Provider Demographics
NPI:1275824716
Name:ANDERSON-RACITI, LIZETH
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:
Last Name:ANDERSON-RACITI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1644
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170-0002
Mailing Address - Country:US
Mailing Address - Phone:212-861-3313
Mailing Address - Fax:212-987-2394
Practice Address - Street 1:420 LEXINGTON AVE.
Practice Address - Street 2:SUITE 1644
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170
Practice Address - Country:US
Practice Address - Phone:212-861-3313
Practice Address - Fax:212-987-2394
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334454-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily